American Association of Clinical Endocrinologists, May 25-29

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The American Association of Clinical Endocrinologists' 25th Annual Scientific and Clinical Congress

The annual meeting of the American Association of Clinical Endocrinologists was held from May 25 to 29 in Orlando, Fla., and attracted approximately 17,000 participants from around the world, including clinicians, academicians, and allied health professionals. The conference highlighted recent advances in endocrinology, diabetes, and metabolism.

In one abstract presented at the conference, Lima Lawrence, M.D., of the University of Illinois at Chicago/Advocate Christ Medical Center in Oak Lawn, and colleagues presented the case of a 65-year-old female with a right-sided adrenal mass that progressively increased in diameter over a nine-year period, from 0.9 cm to over 3 cm.

"We did biochemical testing, which showed the mass was producing significant amounts of cortisol," Lawrence said. "The patient was diagnosed with a cortisol-producing tumor and adrenal Cushing's. She had phenotypic characteristics of Cushing's with supraclavicular fat pads, morbid obesity, anxiety, uncontrolled hypertension, and hyperglycemia."

The investigators planned an adrenalectomy, the standard of care for a patient with a functional, hormone-producing adrenal tumor. "However, during the operation, we found significant peritoneal studding and hepatic lesions, so we were unable to move forward with the planned adrenalectomy," Lawrence said. "Biopsy revealed a low-grade serous tumor of peritoneal origin. Of note, the patient had a history of ovarian cancer for which she had undergone complete hysterectomy and bilateral salpingo-oophorectomy and omentectomy. Subsequently, we presented radiofrequency ablation as an alternative option, and the patient consented."

The patient underwent computed tomography (CT)-guided radiofrequency ablation, which resulted in normalization of cortisol levels, a decrease in the size of the tumor, as well as post-contrast attenuation of CT images. The patient did well after the procedure and was discharged home after 23-hour observation.

"Practicing clinicians, both internists and endocrinologists, should keep in mind that radiofrequency ablation is a safe and effective treatment for adrenal tumors. It is a safe alternative to adrenalectomy when patients are unable to undergo the procedure due to comorbid conditions," Lawrence said. "Practicing clinicians should recognize patients in whom radiofrequency ablation is a preferred option and refer patients to centers that perform the procedure."

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In another abstract presented at the conference, Rahul Suresh, M.D., of the University of Texas Medical Branch in Galveston, and colleagues discussed the risks associated with diabetes when traveling across time zones and how to manage the condition with air travel.

"Many travelers with diabetes and their physicians are unaware of the risks of traveling with diabetes or how to mitigate them. About 10 percent of travelers with diabetes experience a complication related to diabetes treatment, most often hypoglycemia," Suresh said. "When patients travel, their routines change because they are often not eating regular meals or dosing medications appropriately. This is especially true when traveling across multiple time zones."

The investigators discussed how those patients traveling east across time zones have a shorter travel day and tend to have an increased risk of overlapping injectable insulin doses leading to hypoglycemia. In contrast, when travelers are going west, their travel day is extended, increasing their risk of hyperglycemia due to gaps in coverage of injectable insulin.

"We have reviewed the scientific literature to provide an updated and concise summary of recommendations for travelers with diabetes and their physicians on how to adjust insulin regimens during air travel, especially across multiple zones," Suresh said. "We have also provided recommendations on which oral diabetes medications require adjustment and on the safe use of insulin pumps during air travel."

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In a meta-analysis of observational studies, Anawin Sanguankeo, M.D., of Bassett Medical Center in Cooperstown, N.Y., and colleagues found a significant association between vitamin D deficiency and diabetic retinopathy: Patients with diabetic retinopathy had lower serum vitamin D levels compared to patients without diabetic retinopathy.

"The key conclusion is that vitamin D may play a role in the pathophysiology of diabetic retinopathy. Future studies should assess weather vitamin D deficiency has a causal relationship leading to diabetic retinopathy in large populations. Investigators should also see how latitudes and sun exposure affect this association," Sanguankeo said. "There should also be randomized controlled trials to assess the effect of vitamin D supplementation in patients with diabetes and to see whether it reduces the incidence of diabetic retinopathy or slows its progression. Physicians should assess diabetic retinopathy particularly in patients with diabetes who have vitamin D deficiency."

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